Slipped Capital Femoral Epiphysis (SCFE)

Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects children. In SCFE, the ball at the top of the thigh bone slips off the neck of the thigh bone. It is similar to a scoop of ice cream slipping off the top of a cone. This condition causes the hip joint to become painful and stiff.

About one half of SCFE cases affect both hips. SCFE can range from mild, when about a third of the femoral head slips off the thigh bone, to severe, when more than half of the femoral head slips off. Children ages 10 to 16 years are most at risk.

The more severe the case, the more likely the child will experience limited hip motion, differences in leg lengths and further hip problems in adulthood. However, with early detection and proper treatment, a good outcome is possible.

What causes SCFE?

The exact cause of SCFE is unknown. Boys are affected more often than girls. It can result from trauma or occur over an extended period of time. SCFE develops most often during short periods of accelerated growth after puberty has begun.

Risk factors that may increase the chance of SCFE include:

• Obesity
• Medications (such as steroids)
• Thyroid problems
• Radiation treatment
• Bone problems related to kidney disease

What are the symptoms of SCFE?

Symptoms of SCFE typically include complaints of hip pain that is aggravated by activity. Sometimes the child will also experience pain in the groin, thigh or knee area.

In acute slips, the child will complain of immediate pain, limp or feel like the leg is “giving way.” A child with a chronic slip usually walks with a limp, complains of hip pain and says that rest helps alleviate the pain. The child may also walk with his or her leg turned outward.

How is SCFE treated?

The ultimate goal in SCFE is to diagnose the condition early in order to prevent the head of the femur from slipping farther off of the thigh bone, preventing hip deformity.

When SCFE is diagnosed, the child is not allowed to bear weight on the hip. Crutches or a wheelchair may be used.

Surgery is typically required to correct SCFE. There are three types of surgery that may be done:

• Internal fixation (pinning): With the use of fluoroscope as a guide, the surgeon will insert a metal screw or pin through the thigh bone and the growth plate so that they are held in place. The surgeon may use either a single central pin or multiple pins.
• Bone-graft epiphyseodesis: The surgeon removes a rectangular shaped piece of bone from the front part of the thigh bone. A tunnel is created through the growth plate and bony tissue is pushed into the tunnel so that growth plate closure can be achieved.
• Corrective osteotomy: A piece of bone is removed from the thigh bone. This allows the bone to be repositioned without affecting blood supply. The bone is fixed in place with the help of three pins.